514 - Ethics Flashcards
SAD Persons
Who: discussed in ethics and professional issues in counseling
What: psychological assessment tool used to assess suicidality and the main factors associated with suicidal behavior. S- Sex, A- Age, D- depression, P- previous attempt, E- ethanol, R- rational thinking loss, S-social support lacking, O- organized plan, N- no partner, S- Sickness
When: Used when assessing Suicidality
Why: A good model to base judgement on along with clinical judgement.
Example: A client comes into therapy expressing symptoms of depression. The client is an older male who had been diagnosed with a chronic illness. His wife had passed the previous year, and he had no other friends or family. He had started drinking heavily after her death. He reports a past suicide attempt. For these reasons, the therapist begins a suicide intervention.
assent vs consent to treatment
Who: discussed in ethics and professional issues in counseling
What: Assent is someone giving agreement or consent to treatment for someone who is unable to do so because of age or mental capacity. Consent may only be given by individuals who have reached legal age of consent (in the U.S., typically 18).
When: Consent and assent are permission granted by an individual for medical or psychological treatment, participation in research or both.
Why: Ensures that patients are informed on what is going on during treatment and are able to consent to it.
Example: A therapist begins working with a 14-year old client. The client’s mother brought them to therapy and gave consent to the overall therapy, however the therapist asks that the client assent to the therapy or agree to enter the therapeutic relationship.
bartering of clinical services
Who: Discussed in ethics and professional issues in counseling
What: the exchange of goods (chicken, veggies, eggs, etc.) or of services (car repair, house cleaning, painting, etc.) for psychotherapy services. If a counselor decides to barter, they should draw up a contract detailing the terms of the agreement in advance. It should be clearly written and agreed upon between the therapist and client.
Why: This is important because it is a type of boundary crossing. Clinicians can only barter if it does not result in exploitation or harm, if the client requests it or if such arrangements is an accepted practice among the community.
Example: A client was unable to financially pay for his services as his insurance had lapsed. He was skilled in lawn care and an agreement was drawn up between the client and the therapist in which he would provide landscaping services in exchange for her therapeutic services.
basic purpose of ethical practice
Who: Discussed in ethics and professional issues in counseling
What: Primary purpose of ethical practice is to safeguard client’s well-being. Also to safeguard the public. The guiding principles of ethical practice: autonomy, beneficence, nonmaleficence (to not inflict harm intentionally), & justice can assist clinicians in this endeavor. (A,B,N,J). It is important to keep this guideline in mind as we navigate through each client’s situation for example, when to break confidentiality.
Why: It is important to keep this guideline in mind as we navigate through each client’s situation for example, when to break confidentiality.
Example: A therapist has a heavy, stressful, caseload and they receive a client with severe depression and a suicide risk. They refer the client to another therapist with the understanding that doing so is best for their own mental health as well as best for the client and the other clients in their caseload.
confidentiality
Who: part of the ethical guidelines for psychologists
What: confidentiality means that the information between a patient/client and a therapist cannot be shared with anyone. There are a few exceptions to confidentiality, and these exceptions must be explained to the client prior to beginning treatment. Exceptions are: to protect the person from self-harm or inflicting harm on another person, mandated reporter-have the duty to report abuse or neglect of a minor, elder, or intellectually disabled person, may have to release records if court ordered or subpoena sent by a judge.
Why: It is important to know when and when not to break confidentiality as it can damage the therapeutic alliance if not done correctly. It is also important to mention this during the informed consent process to be as transparent as possible.
Example: You are treating a minor and they report to you that their father sexually abuses them. As a counselor you are obligated by law to report this abuse to the authorities. This situation would be an exception to confidentiality.
confidentiality in group or marital counseling
Who: part of ethics, law, and clinical practice
What: confidentiality in group or marital counseling is fundamentally different than the individual counseling setting. The therapist must still maintain confidentiality outside of this group, but there are no guarantees other members of the group/marriage will keep information about the other parties confidential. Additionally, in marital counseling the therapist should make it clear that there can be no secrets.
Why: This is important because keeping secrets can harm the therapeutic alliance.
Example: A couple comes in for marital counseling and are made aware that in marital counseling there can be no secrets. After this is made clear, the husband tells the therapist separately that he still has an ongoing affair that he does not intend to stop. The therapist would have to disclose this to his wife due to the no secrets rule and the effect this information would have on future sessions.
counseling competency
Who: Discussed in ethics and professional issues in counseling
What: Ability to perform according to the standards of the profession involving knowledge, technical skills, and emotional competence. Practicing within the scope of your education, skills, training and experience. Staying up to date with practices by continuing education credits
Why: This is important because counselors must uphold these standards in order to provide the best service and do no harm to the clients. If personal problems arise that may affect a counselors’ competency, they should cease counseling activities and seek adequate measures for these issues.
Example: Fred is a CBT therapist and a client comes in with BPD. He decides to refer her out as he is not certified in DBT and equipped to treat out of his scope.
direct liability
Who: Discussed in ethics and professional issues in counseling
What: a term used to describe where the burden of responsibility lies within a therapeutic relationship. The therapist is directly responsible for their actions, and liability falls under their license. If the therapist is under supervision, the supervisor will be found liable if it was found that their actions were the cause of harm
Why: Holds accountability for license holders. As license holder, if something happens it is also on the supervisor.
Example: A therapist is acting as a supervisor for a trainee and the therapist advises the supervisee to terminate therapy with a patient who was clearly not ready for termination. The therapist, acting as the supervisor, is directly liable for this.
dual/multiple relationships
Who: Discussed in ethics and professional issues in counseling
What: a term used to describe when a clinician has another relationship with a client besides the therapeutic one. The therapist is either concurrently in another relationship with a client, concurrently in a relationship with a person closely associated with the client, or promising a relationship in the future
Why: It is best to avoid multiple relationships if possible because dual relationships affect the therapeutic alliance and/or may impair the objectivity of the treatment relationship.
Example: A therapist begins teaching class at a local college. Later one of their students comes to them seeking therapy services. The therapist tells the student that they cannot see the student as a client as this would constitute a dual relationship and could diminish the therapist’s competency
duty to warn/protect
Who: Discussed in ethics and professional issues in counseling
What: refers to a clinician’s responsibility to warn authorities if one of their clients makes a threat of harm against an individual. Duty to warn means therapists have the responsibility to inform third parties if a client is at risk for harming themselves or another identifiable individual.
Why: The Tarasoff Case established that warning the authorities alone is insufficient and that the therapist must also warn the identifiable individual directly. This would be one of the situations where the counselor is forced to break confidentiality.
Example: A client discloses he is planning on killing his mother within the next day or so. The therapist has a duty to alert the appropriate authorities and the client’s mother to keep her safe from harm.
ethics
Who: Discussed in ethics and professional issues in counseling
What: the standards that govern the conduct of professional members of a group or association, including therapists. We have the American Counseling Association and American Psychological Association.
Why: Conflicts may arise in areas where codes, laws, values, and morals don’t align. It is important to know the code of ethics in your field and differences in law. Generally, ethics are a higher standard than what is required by law.
Example: A therapist works at both a private practice and a local college. When a student comes to them seeking therapy services, they refuse and refer the student to another professional. While having a dual relationship is not illegal it goes against the code of ethics.
ethical boundaries in clinical practice
Who: Discussed in ethics and professional issues in counseling
What: boundaries which limit the nature of therapist and client interaction in order to protect the therapeutic relationship and the client’s well-being. Boundaries in clinical practice may involve physical boundaries (proxemics) and areas of discussion that are off limits.
Why: Therapists must adhere to ethical codes regarding boundaries, but also use clinical intuition/judgment when presented with potential boundary crossings.
A boundary crossing takes the therapist out of a strictly neutral position but is not harmful in and of itself. A boundary violation is a boundary crossing that the therapist knows will harm his/her client.
Example: A therapist agrees to conduct a therapy session while walking because movement helps the client think and dispels some of the client’s anxiety about speaking honestly. This is a boundary crossing that benefits the client.
ethnic-sensitive practice
Who: Discussed in ethics and professional issues in counseling
What: practice in which the counselor is aware of their client’s culture and the ways in which the culture may affect the presentation of symptoms and the views of treatment. Culture can affect a client’s behavior and will be seen differently in each client. It would be unethical to ignore issues like racism while working with minority clients. Practicing ethically leads to better outcomes.
Why: Counselors must be careful and self-aware enough not to apply their own worldview to the clients, but instead, attempt to understand their client’s worldview and the factors that influenced it.
Example: A white counselor is seeing an African American client who is presenting with anxiety. In this case, the counselor must be aware of the client’s view of the police; due to the sociocultural circumstances these views may impact the client’s anxiety.
HIPAA compliance
Who: Discussed in ethics and professional issues in counseling
What: Health Insurance Portability and Accountability Act. Requires the security and privacy of certain personal health information. This upholds a national standard of privacy for clients receiving treatment. Psychotherapy notes are protected under HIPAA and counselors should use technology to aid in this privacy
Why: A therapist must adhere to the HIPAA privacy and security rules in order to protect the information of the patient.
Example: A therapist notifies all new patients in the intake session that this is a HIPPA compliant service. All online documents are secured and will never be shared with an outside source
legal aspects of informed consent
Who: Discussed in ethics and professional issues in counseling
What: A therapist must discuss the limits of confidentiality, the nature of therapy, and the fee structure. In the context of clinical practice, there are three requirements that must be met in order for a person to give informed consent: capacity, comprehension, and voluntary.
Why: It is important for the client to be knowledgeable and have full understanding of what therapy will entail before starting.
Example: In the intake session the therapist made sure to discuss the legal aspects of informed consent which are the limits of confidentiality, that CBT would be the mode of treatment, and the fee structure outlined by the therapist’s policies. The client understands fully of what to expect and is ready for therapy.
